目的 比较住院医师与医学生在沟通课程前对不同医患沟通环节的自评和医患定位,为不同对象开展针对性教学提供参考.方法 抽取北京协和医学院2009年10月至2013年10月期间开设临床医患沟通课程的331名八年制医学生及308名住院医师,使用两个自评问卷的方式进行课前评估,包括医患沟通技能和职业实践的信心问卷和医生患者定位问卷.应用SPSS17.0进行数据处理和统计学分析,采用独立样本t检验.结果 对不同沟通目标的排序,住院医师和八年制医学生均为:收集患者完整的病史评分最高[(4.340±0.756) vs.(4.050±0.707)],建立良好的医患关系次之[(4.310±0.740) vs.(4.030±0.790)],和患者讨论治疗方案再次[(4.050±0.812) vs.(3.600±0.823)],告知坏消息最低[(3.850±0.897) vs.(3.260±0.907)].对于建立良好的医患关系[(4.310土0.740)vs.(4.030±0.790),P＜0.01]、收集患者完整的病史[(4.340±0.756) vs.(4.050±0.707),P＜0.01]、和患者讨论治疗方案[(4.050±0.812) vs.(3.600±0.823),P＜0.01]、告知坏消息[(3.850±0.897) vs.(3.260±0.907),P＜0.01]、整体的医患沟通能力[(4.230±0.796) vs.(3.700±0.808),P＜0.01]的信心评分方面,住院医师组均高于八年制医学生组.医生患者定位量表提示,住院医师组“以医生为中心”的倾向高于八年制医学生组[(60.630±7.665) vs.(3.760±0.828),P＜0.01].结论 住院医师对于医患沟通的自信高于八年制医学生,而“患者为中心”的理念弱于医学生.医患沟通教学的重点在两个群体分布特点相似,八年制医学生教学中需要兼顾其经验不足,住院医师则需要强调共情和换位思考能力的培养.%Objective The purpose of this study was to compare the self-evaluation and doctor-patient orientation between medical students and residents before the courses in different communication sections,and gave guide to different objects for their targeted teaching.Methods We set a sample made of 331 medical students and 308 residents who were trained in Clinical communication skills course in Peking Union Medical College from Oct.2009 to Oct.2013.Before the course,they were investigated by two self-assessment questionnaires.One is communication skills and occupation practice confidence;the other is doctor-patient orientation.Their result data were analyzed and handled by SPSS 17.0 software,adopting an independent samples t test.Results The order of the different aspects of doctor patient communication skills was same in two groups,gathering complete history [(4.340 ± 0.756) vs.(4.050 ± 0.707)] first,and establishing good doctor patient relationship [(4.310 ±0.740) vs.(4.030 ±0.790)],discussing a therapeutic plan with patient [(4.050 ± 0.812) vs.(3.600 ± 0.823)],informing bad news [(3.850 ± 0.897) vs.(3.260 ± 0.907)] followed.According to the self-assessment,residents were more confident than medical students in all these aspects above mentioned and establishing good doctor patient relationship.The doctorpatient orientation scale indicated that the residents group is more inclined to doctor-centric mode than the medical students group.Conclusion This study suggested that the residents is more confident in doctorpatient communication skills than medical students,while is less inclined to patient-centric mode than them.The focus of the communication teaching is similarity in the distribution of the two groups.Medical students' communication curriculum needs to take into account the limited clinical experiences,and training for residents needs to emphasize the capacity of empathy and perspective-taking.
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